RickInOz

… if there are a few typos in this posting, but I have been struggling to defrost my fingers in the mornings and evenings after cycling too and from work. A couple of weeks ago I bemoaned the winter cold, but this was rather premature. For the past few days it has been in low single figures in the mornings and this has made cycling not very pleasant. I thought it got chilly in Leicester, but then our house in Owen Close was well insulated and my Audi had efficient German heating. Houses here are generally poorly insulated for comfort in summer at the expense of heat retention in winter. We’re feeling it at the moment but our current house in North Adelaide is far more energy conservative than the one in Croydon.

Tomorrow night we’re going out for the Mediflight Retrieval Service dinner. It will be a good opportunity to get to know colleagues better, and hopefully this will make working together easier. The director of the imminent Statewide Retrieval Service will also be at the dinner so I can canvass him to make sure my job for next February is confirmed as soon as possible. It is mine in principle, but we are still waiting for funding to come through.

While on the subject I have signed up for another shift on the 4th August, this time during the day as the first on-call. Hopefully I will actually get to do a mission and have something to show for it.

In the meantime I off to get my fingers properly defrosted.

Being a doctor requires more than knowledge and practical ability. Increasingly communication skills have become crucial. This does not simply mean being able to provide explanations to relatives, but also being able to present information to colleagues in a coherent format.

I’ve noticed that many doctors are highly competent on the “shopfloor” yet, put them in a room with their colleagues, turn into jibbeing wrecks. This may sound surprising, but is actually quite common. I’m sure these unfortunate individuals are not unique to medicine, and there are a number of people different professions unable to talk in front of their peers.

The most obvious manifestation of this at work is the quality of PowerPoint presentations. On the whole the standard is good but people forget the most important tenet of audio-visual material, which is that slides should support what you have to say, not replace it.

Common mistake #1

If you put too much text on your slides, people either end up reading it or lose interest. Either way they stop listening. Worse still is if the presenter simply reads the text on the slide, as this makes the presenter completely redundant.

Common mistake #2

You might think your favourite font looks funky, but if it is unreadable on a large screen you might as well have not produced the slides.

Common mistake #3

Putting coloured text against a coloured background only works if there is a significant difference in tone and hue between the two. Many projectors lack resolution and contrast so slides lose definition if colours are not considered properly.

Common mistake #4

Put too much clutter on slides and the message can get lost. Images should support text and not overshadow it.

I know there are a hundred and one other flaws, many of which I am probably guilty of, but the above are the ones that stand out the most for me. This is mostly because it is almost agony having to sit through a poorly executed presentation. The desire to offer constructive criticism is strong, but I tend to keep my opinions to myself, as what bugs me may not bother the rest of the audience.

However, I still stick to the principle that you should still be able to deliver you presentation even if the projector fails and, as such, the slides should augment what you have to say, not steal the thunder.

A little disappointingly I have nothing to show for this post. It should have contained an interesting story about doing my first “solo” retrieval mission. There would have been some pictures too. Unfortunately there was no demand last night, and so we didn’t go anywhere. In a manner of speaking this isn’t a bad thing as it meant no-one was that sick in SA, and there were no serious car crashes.

I’ll have to sign up for some more shifts and maybe have more to show next time.

It’s the end of another week at work. Each day I come home and Regan asks how my day was. Most of the time I say nothing special happened, partly because I am tired and my brain is rapidly fading, but mostly because after a while you become blasé to critical illness.

For no particular reason I just reflected on some of the cases and problems we’ve had on our unit in the past week. Our cases have included three quadraplegic patients (one injured doing gymnastics, one in a car crash and the last due to spinal cancer many years ago), a patient whose cerebral arterio-venous malformation caused a bleed into his brain, a post-operative gastrectomy due to deliberate battery acid ingestion, and an unfortunate man who was electrocuted by high voltage power cables. These are just the tip of the iceberg as we have a steady stream of patients with sepsis, respiratory failure, trauma and substance abuse.

Each patient presents their own challenges and must be managed in a subtly different way. Having specialised in critical care medicine for the past year and a half I don’t see any reason to return to anaesthesia. That speciality has its appeal, but after a while I found myself growing bored. There are only so many ways you can put somebody to sleep, and you only see a snapshot of each case while they are in theatre. ICU provides the opportunity to snatch these patients from imminent demise and not let go of them until they are well enough to fend for themselves.

The next time I say “Nothing special happened today”, perhaps I should consider that what is rather routine and ordinary to us may, in fact, be worth more comment and consideration. So as you can imagine, after a busy week like that I’m looking forward to a duvet day tomorrow. Night all!

All the doomsayers have been making grim predictions about our imminent demise due to rising world temperatures. This week I’m starting to wish it would hurry up.

Winter has well and truly set in, and it has become quite cold of late. The season has also brought some much needed rain to make up for the arid summer. In fact, uncharacteristically for Adelaide, we haven’t seen much sun for the last few weeks.

All of this means I’ve been getting a little soggy on my ride into work over the last couple or duty weeks. However, I’d far rather have this than a return to the heatwave last February. It’s making us feel nostalgic for Leicester, as the above picture shows. Looking forward to seeing you all soon. We’re in the process of drawing up a rough itinerary for our prodigal journey back home, and will release it soon, so free up those diaries now!

When we moved into our current house, we knew the garden was under development and in dilapidated state. To give Neil, our landlord, credit he had sought planning permission to landscape the backyard, had plans for a carport drawn up, and retained contractors to do the work. In typical petty public service bureaucracy, we are still living with a wilderness and waiting for the applications to be processed

We have been making do with this suboptimal yard for 4 months now and finally progress is on the horizon. The planning permission application has been approved and hopefully in the next month or so, we should witness a transformation. In the meantime I felt there was little point in putting a lot of time and effort into maintenance, which has contributed to the overgrowth you can see above. Perhaps before work starts we should invite David Attenborough to examine the microcosm that has sprung up in the absence of human intervention!

Variations on this theme have been going around for a while, and I though it was my time to have a go too.

• You can tell the release number in the first 5 seconds of the warm-up track
• Every other song you hear in the supermarket makes you look around for a bar
• Your non gym junkie friend looks at you strangely when, listening to the radio, you keep saying “Hey this is the [insert muscle group] track from [insert release number]“
• The people in the next car next to you at the traffic lights wonder why you are doing bicep curls
• Your entire wardrobe is red and black
• You have more gym outfits than work clothes
• When you’ve got a little extra cash and buy a new BP top when you really don’t need to!
• You dye your hair red to match your Bodypump clothing
• You avoid ANYTHING that will interfere with your classes
• You get up at 4:45AM to do a class
• Most of your friends are body pumpers
• You pick up a box with a three and one rhythm
• You keep your elbows in when scratching your nose
• You stand in line with your knees slightly bent
• You look forward to using the porta-potties at the music festival
• You judge every person you see by what BP could do for them
• You open your own pickle jars, thank you very much!
• You carry all the groceries in from your car in one trip
• When you sit on the toilet, you pull your hips back, push out you chest and check that your knees don’t go beyond your toe line.
• You go to the disco, on your first song, you move every major muscle group to properly warm up.
• You prefer to eat donuts with your thumb in the hole!
• You get mooned and instead of being offended you correct their form!
• You’ve never been back to the weight room since you started BP!
• You can’t lift weights without music!
• You think a song sounds better in BP class, than it does on the radio.
• When you go to sit down on the couch, you do a few squats first
• You have nightmares of missing your classes, or being late
• You dream about Bodypump

I’m sure there are plenty I’ve missed but I’ve tried to cull duplicates as much as possible. Feel free to add any you think merit inclusion.

For those who have been on tenterhooks for the past year, ever since this posting, here at last is the follow-up.

Shortly after arriving in Adelaide last year my dodgy old crowns started to break apart. This left me with a very unattractive smile. One crown was an offensive off-yellow with a split down the middle. The other was a grey peg tooth. I’d put up with these for some time for financial reasons and lack of motivation. However being afraid to show one’s teeth is a significant blow to self-confidence.

Spyro, my dentist, has really shown off his expertise. In conjunction with his preferred dental technician he has created some incredibly faithful replicas of my natural teeth. Firstly I did some home teeth whitening to recover years of staining from food. Then we carefully matched colour, lustre, translucency and shape. Technology has come along way from the era of gold and amalgam crowns, as mine are made of a specialised blend of ceramics and glass. The end result is flawless and I’m sure people won’t be able to tell the difference.

In a makeover inspired montage, here are the before …

… and after pictures:

It’s nice to have this completed. For the first time in almost 20 years I can smile, beam, smirk or grin with confidence.

Over the past few months I have undergone a fair amount of training and preparation with the Mediflight Retrieval service. Not long ago I finished the requisite competencies and was signed off to “go solo”.

Annoyingly, after all that effort, there are are no shifts available. When I signed up there was a shortage of people to fill slots and I was forever getting text messages asking for volunteers. Now I’m ready to go there are no opportunities!

I’m sure something will come up and I’ll do my best to remember my camera and share the experience with you all.

After the days off and frivolities in the sea I’m back at work again this week. I thought I’d share an aspect of critical care medicine that plays an unseen, yet important, influence.

As I’ve mentioned in a previous posting, the intensive care unit as a whole is measured and assessed by successful outcomes and comparison versus an accepted standard. How then do you measure performance of individuals? The most common method is examinations, but this only captures a snapshot. Doctors abilities and knowledge can fluctuate and may not always meet the demands of the job. Fortunately working in a team-based environment tends to encourage good standards and a degree of automatic quality control.

Another variable, and this is the point of my post, is practical skill. When doctors are recruited, their CVs are reviewed, an interview may be conducted and referees canvassed. However the future employer, and their staff, still have no idea whether that applicant will be able to do the required tasks. Therefore for relatively new staff like me there is a certain amount of pressure to perform as expected. This is most tangible when doing practical procedures.

Today I was asked to insert a pulmonary artery catheter in one of our patients. Unexpectedly I had an audience, of junior medical colleagues who wanted to see how it was done, and senior nurses learning how the new ICU monitors worked. My hands were shaking a little being under the hammer like that, but fortunately it went smoothly and my reputation was secure.

It is not always that way. From time to time I, like many of us, make mistakes and am unable to complete procedures as intended. In such a situation I tend to give myself a mental kicking, despite full insight that nobody is perfect and it usually doesn’t matter that much. While procrastination isn’t healthy, it does serve as a valuable internal quality check. So hopefully standards are maintained and there is no need for more frequent exams!